Arch Surg Chicago
-
Division of the pyriformis muscle at its tendinous insertion was employed for the treatment of sciatica in 14 patients with postlaminectomy syndrome and osteoarthritis of the spine. Of these patients, 85% had satisfactory results. It is logical that the pyriformis muscle can play an important role in the production of sciatic associated with intraspinal lesions. Tension on the sciatic nerve, which passes in close approximation to the pyriformis muscle anteriorly, can be relieved by division of the pyriformis muscle.
-
The modern, positive approach to treatment of injuries of the cervical spine and spinal cord has produced excellent long-term survival, but less progress has been made in reversal of the neurologic defect. Injuries to the spinal column are of four types: flexion-dislocation, hyperextension, vertical compression, and rotation. Those to the spinal cord also involve four categories: morphologic damage, hemorrhage and vascular damage, structural changes, and biochemical response. ⋯ These results, and those of surgery on the experimental lesions, have been hopeful, but not definitive. Controversy surrounds the surgical vs nonsurgical treatment of clinical spinal cord injury. Operation is indicated for roentgenographic evidence of bone fragments in the spinal canal, for worsening neurological symptoms, and, possibly, if experimental evidence is to be followed, for surgical decompression in the very early minutes or hours after injury.
-
Twelve children with acute abdominal pain, which was suspected of being acute appendicitis, were subsequently found to have lower lobe pneumonia. Diagnostic barium enema or operative exploration failed to demonstrate any appendiceal abnormality. ⋯ Contrary to common belief, it was observed that left-sided pneumonia is capable of mimicking appendicitis almost as frequently as right-sided pneumonia. Since the likelihood of acute appendicitis accompanying pneumonia is small, operative intervention is rarely indicated and should be undertaken only after careful and intensive investigation.
-
Tracheal stenosis is not an uncommon sequel of prolonged endotracheal intubation. In some cases, immediate reconstruction is not feasible. We use the flexible fiberoptic bronchoscope and a lucent, tapered endotracheal tube for tracheal dilation. The fiberoptic bronchoscope is passed through a special T connector into the endotracheal tube and used to guide the tube under direct vision through the stricture.